{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA K LANGLEY","gend":1,"add":"1430 FLANARY BRIDGE RD  ","city":"JONESVILLE  ","state":"VA","zip":"24263-9998","dob":"1981-05-23","age":"","mstatus":"","insh":11016775,"cliId":"3HM6V28WP49","pno":2763467868,"cno":2763467868,"email":"","ename":"","eno":"","pphy":"YEARY, JOSHUA ADAM","ppno":2764454826,"pcpadd":"1446 Dr Thomas Walker Rd","pcpcity":"Ewing ","pcpstate":"VA","pcpzip":242488307,"pcpcounty":"","pcpid":"P9059248","pcpname":"WESTERN LEE COUNTY HEALTH CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1430 FLANARY BRIDGE RD  ","madd2":"","madd3":"","mcity":"JONESVILLE  ","mstate":"VA","mzip":"24263-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H16.223","K52.9","K21.9","R14.0","G47.33","F41.9","F32.9","Z79.899","K58.2","K22.4","M79.673","S80.01XA","W19.XXXA","Z83.3","E53.8","E55.9","Z71.89","Z13.89","Z13.9","Z00.8","R00.2","M54.5","I42.1"],"date":["2021-01-13","2021-02-11","2021-02-23","2021-02-23","2021-02-10","2021-02-11","2021-02-11","2021-02-11","2021-07-15","2021-02-23","2021-02-23","2021-05-21","2021-05-21","2021-04-20","2021-04-20","2021-04-20","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-11-12","2021-07-15","2021-11-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",null,"",null]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","16714012303","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","45802004064","SELENIUM SUL","LOT 0.025","","Select","Select",""],["","115521116","COLESTIPOL","TAB 1GM","","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","","Select","Select",""],["","527128201","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","527128201","DICYCLOMINE ","TAB 20MG","120","Select","Select",""],["","16714012303","OMEPRAZOLE ","CAP 40MG","60","Select","Select",""],["","45802004064","SELENIUM ","LOT 0.025","120","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","2","Select","Select",""],["","115521116","COLESTIPOL ","TAB 1GM","60","Select","Select",""],["","16714001401","AMOX\/K","875-125","20","Select","Select",""],["","45802004064","SELENIUM","0.025","120","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","20","Select","Select",""],["","58657067601","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","16714001401","AMOX\/K ","TAB 875-125","20","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}